Transcript Drug use on the rise

Chapter 7
Depressants and Inhalants
© 2006 McGraw-Hill Higher Education. All rights reserved.
Depressants
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Most widely-used and abused drugs in
the U.S
Is popular for its stress and anxiety
relieving properties
© 2006 McGraw-Hill Higher Education. All rights reserved.
© 2006 McGraw-Hill Higher Education. All rights reserved.
© 2006 McGraw-Hill Higher Education. All rights reserved.
Benzodiazapines
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Introduced in 1960s
40 years drug of choice
Many properties – anxiolytic, sedatives,
anticonvulsants, relaxant
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Benzodiazapines
Effects
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Safer than barbiturates
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Much less respiratory depression
Replaced barbiturates as the drug of choice
Doses rarely fatal
CNC toxicity in chronic use/high doses
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Headaches, irritability, confusion, impaired
memory, depression
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Types of CNS Depressants
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Benzodiazepines: Valium-Type drugs
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Prescribed for anxiety and sleep
Four of the top-selling prescription drugs in the U.S.
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Xanax, Halcion, Ativan, diazepam
Medical uses
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Relief from anxiety, neurosis, muscle relaxation,
alleviation of lower-back pain, treatment of convulsive
disorders, induction of sleep, relief from withdrawal
symptoms, induction of amnesia
© 2006 McGraw-Hill Higher Education. All rights reserved.
Types of CNS Depressants
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Types of benzodiazepines:
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Side effects:
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14 benzodiazepine compounds on the market
Distinguished primarily by their duration of action:
short-acting (hypnotics), long-acting (sedatives)
Drowsiness to paradoxical effects (i.e. Rophynol,
used to make victims vulnerable to sexual assault)
Tolerance, dependence, withdrawal, and
abuse
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Pharmacokinetics
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Wide range of half-life, 3 mins to 120 hrs
Redistribution
 Fast acting – lipid (fat) soluble- results in
seconds
 Long acting p water soluble – slower to
penetrate (CNS 20-30 mins)
 Metabolize in the liver eliminated through
kidneys
© 2006 McGraw-Hill Higher Education. All rights reserved.
History
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Before Barbiturates:
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Chloral hydrate was first synthesized in1832
but not used clinically until 1870– for sleep
Paraldehyde was first synthesized in1829 but
not used clinically until 1882 – very safe –
very, very bad taste and odor
Bromides – to induce sleep in the 19th
century, used until 1960s in OTC meds
© 2006 McGraw-Hill Higher Education. All rights reserved.
History
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In the 1950s the first benzodiazepines
were marketed as substitutes for
barbiturates
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Relatively safe when used for short periods
Long-term use can cause dependence and
withdrawal problems
© 2006 McGraw-Hill Higher Education. All rights reserved.
Action Sites and Mechanism
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Early understanding
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Depressed neuronal pathways in brain
stem/cerebral cortex
Present day
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Reduced metabolic and brain electrical
activity
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Neurotransmitters and Receptor Sites
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Glutamate (excitatory)
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Reduce excitatory activity
GABA (inhibitory)
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Augment inhibitory activity
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Barbiturates/benzodiazapines bind here
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Effects of CNS Depressants
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CNS depressants reduce CNS activity and
diminish the brain’s level of awareness
Depressant drugs include:
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Benzodiazepines
Barbiturate-like drugs
Alcohol
Antihistamines
Opioid narcotics like heroin
GHB (gamma hydroxybutyrate)
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EFFECTS ON THE CNS
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The clinical value of CNS depressants is
dose dependent
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Low dose (sedatives, relieves anxiety and
promote relaxation)
Higher doses (hypnotics, can cause
drowsiness and promote sleep)
At even higher doses (anesthetics, can cause
anesthesia and are used for patient
management during surgery
© 2006 McGraw-Hill Higher Education. All rights reserved.
Effects of CNS Depressants
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The clinical value of CNS depressants is dose
dependent:
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Low dose (sedatives, relieve anxiety and promote
relaxation)
Higher doses (hypnotics, can cause drowsiness and
promote sleep)
At even higher doses (anesthetics, can cause
anesthesia and are used for patient management
during surgery)
© 2006 McGraw-Hill Higher Education. All rights reserved.
EFFECTS OF CNS DEPRESSANTS
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CNS depressants reduce CNS activity and
diminish the brain’s level of awareness
Depressant drugs include:
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Benzodiazapines
Barbiturates
Alcohol
Antihistamines
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Opiods
GHB (gamma hydroxy-butyrate
Psychological Effects
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Depressed Behavior
Cognitive/Motor inhibition akin to alcohol
inebriation
Low dose – reduced anxiety or emotional
withdrawal
High doses – general behavioral
depression, sleep
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Physiological Dependence
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Wide range of effects
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Low dose sleep difficulties
High dose- hallucinations, restlessness,
disorientation, life-threatening convulsions
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Psychological Dependence
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Pleasurable effects
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Reduced anxiety
Sedation
Euphoria
Leads to compulsive use and abuse
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Mental Status Exam
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Used to evaluate mental functioning
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Five areas
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Sensory - clouded, disorientation to time/place
Memory – forgetfulness
Intellect – depressed reasoning
Judgment – altered insight
Affect – wide mood swings
© 2006 McGraw-Hill Higher Education. All rights reserved.
INHALANTS
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Inhalants are breathable chemical
vapors that produce psychoactive (mindaltering) effects.
They were never meant to be used to
achieve an intoxicating effect
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Inhalants falls into the following categories
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Volatile Solvents – industrial or household
solvents containing products, including
paint thinners or removers, degreasers,
dry cleaning fluids, gasoline and glue
Art or office supply solvents, including
correction fluids, felt tip marker fluid, and
electronic contact cleaners
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Inhalants fall into the following categories
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Aerosols – Household propellants and
associated solvents in items such as spray
paints, hair or deodorant sprays, fabric
protector sprays
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Inhalants fall into the following categories
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Gases – used in household or commercial
products, including butane lighters and
propane tanks, whipping cream aerosols
or dispensers, and refrigerant gases
Medical anesthetic gases, such as ether,
chloroform, halothane, and nitrous oxide
(laughing gas)
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Inhalants fall into the following categories
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Nitrites – organic nitrites are volatiles that
include cyclohexyl, butyl, and amyl nitrites,
commonly known as poppers. Amylnitrites
is still used in certain diagnostic medical
procedures. It has an unpleasant odor
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Who Use Inhalants
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Among youths age 12 to 17 10.6% were current
users
Among 12 or 13 year olds, 1.2% report current
use
1,6% of 14-15 year olds reported current use
Life time use was down in 2004 among
Americans 18-20
2004 National Survey on Drug Use and Health
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How are Inhalants Used
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Sniffing or snorting fumes from containers
Spraying aerosols directly into the nose or mouth
“Bagging,” sniffing or inhaling fumes from substances
sprayed or deposited inside a plastic or paper bag
“Huffing” from an inhalant-soaked rag stuffed in the
mouth
Inhaling from balloons filled with nitrous oxide
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Inhaled chemicals are rapidly absorbed through
the lungs into the bloodstream and quickly
distributed to the brain
Nearly all abused inhalants (other than nitrites)
produce pleasurable effects by depressing the
CNS
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Gaseous Anesthetics
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Nitrites
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Rapid dilation of the arteries, great for blood
pressure
Unpleasant smell
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Recognizing Inhalant Abuse
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Chemical odor on clothing or breath
Drunk or disoriented appearance
Pain or other stains on face, hands, or clothes
Slurred speech
Hidden empty spray paint or solvent containers and
chemical-soaked rags or clothing
Inattentiveness, lack of coordination, irritability and
depression
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Effects of Inhalants
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Slows body functions
Intoxication
Nausea
Cough/sneeze
Light-headedness
Damage heart, kidneys, brain
Hypoxia/death
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Medical Consequences of Inhalant Abuse
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Asphyxiation from repeated inhalations
Suffocation from blocking air from entering the
lungs
Convulsions or seizures caused by abnormal
electrical discharges in the brain
Coma
Choking from inhalation of vomit
Fatal injury from accidents
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Dangers of Inhalants
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Chronic long-term use can lead to brain
damage, liver, kidney, heart, fetus
Accidents associated with “intoxication”
and fires
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Harmful Irreversible Effects
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Hearing lost
Peripheral neuropathies, or limb spasms
Central nervous system or brain damage
Bone marrow damage
© 2006 McGraw-Hill Higher Education. All rights reserved.
Side Effects of Depressants
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Drowsiness to paradoxical effects (I.e.
Rophynol, use to make victims vulnerable
to sexual assault
Tolerance, dependence, withdrawal, and
abuse
© 2006 McGraw-Hill Higher Education. All rights reserved.